Coiling a Type II Endoleak With a 2-RO, 155-cm Direxion™ Microcatheter

BY YING WEI LUM, MD

CASE DESCRIPTION AND DISCUSSION

A patient presented with a type II endoleak with a long and tortuous feeding vessel, which we believed to be the inferior mesenteric artery (Figures 1 and 2). After we initially gained access with a SIM1 diagnostic catheter and advanced more distally with a 0.021-inch (0.53‑mm), preshaped, 2-RO-tip Direxion™ Microcatheter, we ran out of length because the 100‑cm SIM1 catheter would not allow us to reach the target. We switched out the entire system, using only a 300-cm-long, 0.014-inch (0.36‑mm) Fathom® Guidewire. The Fathom®‑14 Guidewire provided plenty of support for the exchange, and we did not need to open an additional device such as a long sheath. We advanced a longer, 4-F (1.33-mm) nontapered, angled diagnostic catheter into the inferior mesenteric artery and then reinserted a 155-cm Direxion™ Microcatheter, one of the longest microcatheters on the market. We needed every last centimeter of the 155-cm length, as we used the Direxion™–Fathom® combination to access the target endoleak site and prepare for coil embolization (Figure 3). 

We deployed six Interlock™‑18 Coils precisely into the aneurysm sac, with help from the two radiopaque markers on the Direxion™ Microcatheter, and left the last coil to trail out into the feeding vessel as an anchor (Figures 4 and 5). To keep cost in mind, we finished the embolization with a few small VortX® Diamond 0.018-inch (0.46-mm) pushable coils to finish packing the coil nest. 

The flow to the endoleak site drastically diminished (Figures 6–8), and we feel strongly that the Dacron fibers on the Interlock™‑18 Coils will continue to thrombose and create a complete occlusion.

Figure 1
Figure 3
Figure 5
Figure 7
Figure 2
Figure 4
Figure 6
Figure 8

Ying Wei Lum, MD
Vascular Surgeon
Johns Hopkins Hospital
Baltimore, Maryland
Disclosures: Received no compensation for this article and is not a consultant to Boston Scientific Corporation.

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.

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